Ob-Gyn Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Question: I recently billed for a bilateral uterosacral ligament neurectomy along with a 56303-22 (laparoscopy [peritoneoscopy], diagnostic; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by an method; unusual procedural services) that was completely denied. What is the code for this procedure?

Bobby Meyers, Office Manager
Robert T. Byington, MD, Lincoln, Neb.

  Answer: The procedure, laparoscopic uterosacral nerve ablation (commonly referred to as a LUNA), involves the interruption by laser vaporization, electrosurgery or transection of the uterosacral ligament. It is done to help relieve central pelvic pain when other causes of the pain cannot be confirmed. The problem with this procedure is that it is not a standard of care for the treatment of pelvic pain, and in fact is still considered to be an experimental procedure by the American College of Obstetricians and Gynecologists. For this reason, the American Medical Association (AMA) CPT Editorial Panel has rejected requests to add a code for this procedure.

Your only hope of getting paid for the procedure is to convince the insurance company that this was a procedure of last choice (which it usually is). You need to submit peer-reviewed journal articles about this procedure and provide the payer with a letter describing why this was the treatment of choice for the pelvic pain. As there is no code in CPT for this procedure, you could add a modifier -22 (unusual procedural services) to the primary surgical code. Note: Code 56303 was deleted from CPT in 2000. The new code is 58662 (laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method). Alternatively, you could list the primary code and then report the unlisted laparoscopic code that would best describe the body area the procedure is performed on (49329, unlisted laparoscopy procedure, abdomen, peritoneum and omentum).

Source for You Be the Coder is Melanie Witt, RN, CPC, MA, former program manager for the American College of Obstetricians and Gynecologists (ACOG) department of coding and nomenclature and an independent coding educator.